Monday, May 8, 2017

MOCA 2.0 Scoring Explained

A couple of years ago, physicians around the country were up in arms over the strong arm tactics of their medical boards coercing them to pay for ever pricier exams in order to maintain their board certifications. These monopolistic, non elected board members used their positions of power to enrich themselves and their organizations at the expense of doctors, since many would not be allowed to practice their craft without the precious certificates.

The American Board of Anesthesiology too felt the pressure to reform the process. In response, they developed MOCA 2.0. One of the biggest advances of MOCA 2.0 is the elimination of the once a decade recertification exam. Instead of studying furiously like taking your first written boards, the ABA replaced it with an annual 120 question MOCA Minute. Each quarter, the anesthesiologist is supposed to answer 30 questions to track their progress in maintaining their knowledge base.

This makes recertification a lot less intimidating than taking another do or die exam every ten years. However there were always questions about how the MOCA Minutes were being scored. If you take one exam, it's easy to decide where you fit on the curve and whether you've passed or failed. But how do they score mini exams every quarter over ten years? How do they know if you've been reading your journals and reviewing your texts? Well the ABA has a website for that, and it isn't pretty.

As you can imagine, trying to decide if somebody is maintaining their anesthesia knowledge every three months is quite convoluted. They use something called the Measurement Decision Theory to calculate if you're smart enough to maintain your board certification. It looks something like this:

Got that? It looks like something out of your biostatistics class that you slept through in medical school. Basically the MDT starts out with the premise that the physician has a 97% chance of keeping his certificate, since that was the average passing rate prior to MOCA 2.0. Now each MOCA Minute question has a difficulty value assigned to it. How this is determined is not mentioned. The ABA then compares the chance of answering the question correctly from doctors who passed the recertification in the past versus doctors who didn't. Then it passes through several more calculations to come up with the likelihood that you would pass board recertification. In their example, the physician has a 98.6% chance of passing versus 1.4% chance of failing. So the doctor gets to practice another ten years.

So if you're one of those slackers in medical school who graduated by the skin of your teeth, how low a score can you get and still satisfy the ABA requirements for maintaining your knowledge base? First of all it's not that hard. Here is my score so far:

Remember that the higher the score the more likely you'll pass the former recertification exam. Mine so far is 1.0 so basically I have a 100% chance at being successfully recertified. And believe me, I am no anesthesia savant. But I do a competent job and have been in practice for nearly 15 years. The minimum score that the ABA will tolerate for meeting their standards is an MDT score of just 0.1. That's right. You can have a 90% chance of failing and still be within the ABA's guidelines for maintaining recertification.

Basically our professional careers and livelihoods are now governed by game theory. Whether this is an improvement over the previous one-exam-to-rule-them-all has yet to be determined. In the meantime, download the app and do your quarterly mini tests in the comfort of the operating room during one of those interminable multi hour cases. You'll be finished with your ABA obligations sooner than it takes for the surgical intern to close that skin incision.